Provider Demographics
NPI:1568052488
Name:BRADLEY, CANDICE PATRICE
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:PATRICE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 GADSDEN HWY APT D99
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-2453
Mailing Address - Country:US
Mailing Address - Phone:205-516-0142
Mailing Address - Fax:
Practice Address - Street 1:544 GADSDEN HWY APT D99
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-2453
Practice Address - Country:US
Practice Address - Phone:205-516-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional